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To the Editor: The current management of patients with ACS entails the use of potent antiplatelet medications (aspirin, clopidogrel, IIb/IIIa receptor antagonists), anticoagulants (unfractionated heparin, low-molecular-weight heparin), and sometimes fibrinolytics. These drugs, particularly when used in combination, can make practicing cardiologists worry about an excess risk of upper gastrointestinal (GI) bleeding and therefore prescribe PPIs in an attempt to reduce this risk. The study by Dr Ho and colleagues¹ showed that the concomitant use of PPIs and clopidogrel in patients with ACS may increase the risk of adverse outcomes, presumably by reducing the antiplatelet effects of clopidogrel.²

There was a very high use of PPIs in ACS patients (64%), although there have been no well-designed randomized studies showing that PPI use reduces the risk of upper GI bleeding in these patients. The authors did not report the actual rates of upper GI bleeding in their cohort of patients. It would . . . [Full Text of this Article]

Habib A. Dakik, MD
hd01@aub.edu.lb

Kassem Barada, MD
Department of Internal Medicine
American University of Beirut
Beirut, Lebanon

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